Experience With Vesicoureteral Reflux in Children: Clinical Characteristics

Abstract

Almost half of the children with vesicoureteral reflux have no history of culture proved urinary tract infection. Scarring may be associated with any reflux grade and it may be initially diagnosed at any age. Only half of the scars are noted with higher grades of reflux (IV and V). Continuous prophylaxis prevents new scarring. Breakthrough infections are rare but they can occur at ages greater than 7 years. Two consecutive negative cystograms are necessary before discontinuing prophylaxis. Children should be monitored after reimplantation for recurrent urinary tract infection.

Urinary Tract Infection in Children

“…8 We found no convincing evidence of benefit from routine diagnostic imaging of all children with a first urinary tract infection. However, subgroups of children at increased risk of future morbidity may benefit from investigation.…”

“…8 It is not possible to clinically identify children who are at high risk of subsequent urinary tract infections and long term damage. 8 Routine prophylaxis until the results of investigations are known may therefore be warranted.…”

Vesicoureteral Reflux and Antibiotic Prophylaxis: Why Cohorts and Methodologies Matter

“…Of those 4 with the lowest initial scar rates, reported outcome scarring ranged from 0.5 to 35% and reported recurrent UTI rates were 13%. [4,9,15,16] The remainder with higher initial scarring rates reported recurrent UTI rates ranging from 14 to 50% and scarring at outcome ranging from 3.5 to 35%.…”

“…Greenfield [ 15 ] and Skoog [ 4 ] were retrospective studes, while the remainder were prospective. The gender distribution differed widely.…”

“…Studies from North America were predominately female-72 to 100%. [4,5,9,15] Males were overwhelmingly dominant (80%) in the one study from Japan. [6] Males comprised 30 to 50% of the cohort in 8 studies -all from countries were routine neonatal circumcision is not practiced.…”